MEDICARE: CONSCIOUSNESS HOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1164177903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSCIOUSNESS HOUSE

Provider Business Mailing Address
First Line	:	121 E STEELE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-3908
Country	:	US
Telephone Number	:	407-462-0845
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 E STEELE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-3908
Country	:	US
Telephone Number	:	321-765-3102
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	DR. ANNIE LAURIE MADDOX
Credential	:	PHD
Telephone Number	:	321-765-3102

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/21/2022

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Directions to “CONSCIOUSNESS HOUSE ” Practice Location

Language	Start Address	Practice Location

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